1. DISTRESSED, DISRUPTIVE, & POTENTIALLY DANGEROUS STUDENTS Helping Faculty & Staff Develop Effective Responses to Students of Concern JOHN ACHTER, PH.D. LICENSED PSYCHOLOGIST, DIRECTOR UW-STOUT COUNSELING CENTER Fall 2008

2. Goals Articulate faculty & staff roles in identifying and responding to student behavior of concern Identify key areas and behavioral indicators of concern Develop strategies for and comfort with responding Know resources and mechanisms for consultation, reporting, and referral

3. Establishing a community of caring: why? Student distress is real and on the rise—and it impacts academic performance and persistence in school While more students are seeking help, many still do not due to stigma or other reasons Often those with the most serious needs don’t seek help without encouragement Those who seek help are more likely to persist in school— but they must stay with it Faculty & staff are the front lines with esteemed status among students – in prevention parlance, you are “gatekeepers” Because it’s the right thing to do?!

4. Establishing a community of caring: how? Resiliency factors we can control ◦ High expectations & clear boundaries ◦ Caring/supportive environment and role models ◦ Opportunities for meaningful engagement Expect the best from students & focus on strengths Tell students you care... And show them Promote appropriate faculty-student and student- student relationships Approach students when you notice changes or concerning patterns in behavior Individual approaches that work for you?

5. Distinguishing between distressed, disruptive, and dangerous behavior Distressed: Behavior that causes us to feel alarmed, upset or worried (most common) Disruptive: Behavior that interferes with or interrupts the educational process of other students or the normal business functions of the university Dangerous: Behavior that leaves us feeling frightened and in fear for our personal safety or the safety of others General rule: If it doesn’t feel right, it’s usually not right! (trust your gut)

6. Common categories/causes of student distress Depression Anxiety/stress Disordered eating Self-injury Alcohol/drug problems Sleep problems Serious mental illness (e.g., bipolar, schizophrenia) Serious illness/injury Relationship violence/ assault Relationship break-up Academic pressure or failure Career indecision Identify confusion Adjustment problems Unplanned pregnancy Family issues Death/loss Discrimination/alienation Legal difficulties

7. NCHA/ACHA Student Data % within the past school year.2000200220042006 Felt very sad80.682.080.977.8 Felt depressed44.444.845.142.2 Been diagnosed with depression10.311.814.914.5 Seriously considered attempting suicide9.510.010.19.4 Attempted suicide1.51.61.4 * 75% of college suicides occur among students who have not accessed counseling services *Beginning fall 2008, Stout will be requiring 3 sessions of assessment for students making suicide attempts or threats

8. Signs of Distress - Academic Excessive absences or procrastination Withdrawal/fatigue/sleeping in class Avoidance of or change in participation Excessive anxiety regarding performance Uncharacteristically poor preparation or performance Repeated requests for special consideration Unusual or inappropriate expressions in writing, drawing, or other coursework (note: if content is violent in nature, notify SOC)

9. Signs of Distress - Behavioral Change in mood (e.g., depressed or irritable) Hyperactivity or very rapid speech Difficulty concentrating Physical complaints (e.g., headaches, stomachaches) Deterioration in hygiene and self-care Dramatic weight loss or gain Unusual or exaggerated emotional expression Impaired/disjointed speech Swollen or red eyes Smell of alcohol, marijuana or signs of other drug use Observable signs of injury

10. Signs of Distress - Interpersonal Problems with roommates, family, or romantic partners Significant death or other loss Social withdrawal Difficulty get along with others Frequent conflicts with others Dependency on peers, staff or faculty Concerns and complaints from other students

11. Video clip – Everything’s a Mess Notice what signs and symptoms this professor sees and hears from the student that leads him to encourage the student to seek counseling services http://www.sa.psu.edu/caps/distress/distress/r ecognizing_video.html

12. Responding to the distressed student Observe – Take note of verbal & non-verbal behavior that suggest signs of distress Trust your gut – It is better to error on the side of safety and concern by doing something Reach out – Ask to talk in private and share your observations in a direct and nonjudgmental manner Listen – Encourage the student talk and listen to both thoughts and feelings Offer support – Your care, interest and listening may prove pivotal in the student seeking help Give hope – Let them know things can get better and you will help identify options for assistance

13. Responding to the distressed student Consult – If you feel unsure or “in over your head,” utilize the Counseling Center or other resources for assistance Refer – To counseling or other campus resources, if appropriate. Frame seeking help as a sign of strength Maintain boundaries – Be clear and consistent about expectations and honest about the limits to your ability to help Follow-up – Arrange a time to check back with the student. This communicates continued care and interest

14. Boundaries: Consider referral when... The student expresses openness to receiving help There is immediate danger to student or someone else The problem or request is beyond your expertise or job role Personality differences interfere with your ability to help Your objectivity is compromised, perhaps due to a personal relationship The student is reluctant to talk to you about the problem You are feeling overwhelmed, pressed for time, or otherwise at a high level of stress

15. Signs of Distress – Suicide Risk Threatening to hurt or kill oneself; talking or writing about death, dying, or suicide Suicide planning behavior/access to lethal means Overwhelming hopelessness & helplessness; feeling trapped – like there is no way out Past attempts or other self-injurious behavior Dramatic mood changes; feeling rage, anxiety, agitation Reckless or risky behavior, incl. increased AOD use Withdrawing from friends, family, society Putting affairs in order/giving away possessions

16. Why address suicide risk factors? Suicide is the 2nd leading cause of death in college students (after accidents); accounts for more deaths than all illnesses combined 55% of college students report suicidal thoughts at some point in their life; In a given year, 6-10% have “seriously contemplated suicide”; 8% have made a plan; 1-1.5% make an attempt (2007 ACHA; 2008 U of TX study) ◦ 50% consider counseling; only 40% seek it out (MTV/AP 2008) 75% of college suicides occur among students who have not accessed counseling services Effective treatment is available (and free on campus)!

17. Addressing suicide Think QPR (Question, Persuade, Refer) Q – If concerned, ask directly about suicidal thoughts and feelings P - If the answer is yes, obtain agreement to seek help R – Refer for professional assessment Don’t promise secrecy As always, listen, show concern, and follow- up. Also take care of yourself!

18. The Disruptive Student Problems with boundaries and expectations; pushes the limits Incivility/verbally lashing out or intimidating others (including online) Overly demanding of faculty, staff, or peers Makes hostile remarks out of turn Dominates discussion/“takes over” class Over reaction to changes in policies or setting reasonable limits

19. The Disruptive Student – what to do Confront directly and early by verbally requesting that the student stop the behavior If behavior is in public and persists or escalates, ask the student to leave the class or area Establish a time to talk privately, informing student that their behavior needs to change and explaining consequences for not abiding Postpone conversation if student is defiant or hostile Document exact words and actions, including dates, times, & behaviors; keep emails, voicemails, etc. Report concerns in a timely manner to DOS ◦ “If you see something, say something” (NYC MTA)

20. The potentially dangerous student Verbal or written threat of suicide, homicide or assaultive behaviors Displays a firearm or other weapon Unusual interest in weapons, security, or targets Approval of violence to resolve problems Attempts to harm self Physically confronts or attacks others Stalks or harasses others Sends threatening emails, letters, and other correspondence

21. The potentially dangerous student – what to do Immediately contact University or Menomonie Police at 911 Contact department chair or supervisor for advice, support, and documentation Inform the Dean of Students Office and consider filing a student behavior complaint Consult with the Counseling Center to debrief and assist you, other staff, and students

22. Students of Concern Team Chaired by Dean of Students (232-1181) with membership from Counseling Center, Disability Services, Student Health Services, University Housing, & University Police They serve an important role as both a “vortex” for information, and also a multidisciplinary team of consultants Can be of assistance with all three levels of concern, but most critically with the disruptive or potentially dangerous student

23. Resources Campus: Students of Concern Team – 232-1181 Dean of Students – 232-1181 Counseling Center – 232-2468 Health Services – 232-1314 Stout Police – 232-2222 Menomonie Menomonie Police – 911 Red Cedar Medical Center – 235-5531 National: 1-800-SUICIDE (Hopeline network) 1-800-273-TALK (Suicide Lifeline)

24. Resources Internet Counseling Center (www.uwstout.edu/counsel)www.uwstout.edu/counsel Assisting Students During Emotional Distress: A Guide for Faculty and Staff (UW-RF document covers specific disorders & problem areas) (http://www.uwrf.edu/counseling/documents/7030%20Student%20Crisis%20II.pdf(http://www.uwrf.edu/counseling/documents/7030%20Student%20Crisis%20II.pdf) Responding to Disturbing Creative Writing (VATech): http://www.colorado.edu/studentaffairs/victimassistance/quickassist/disturbingwriting.pdf http://www.colorado.edu/studentaffairs/victimassistance/quickassist/disturbingwriting.pdf Writing in the Margins (UCDavis): http://caps.ucdavis.edu/resources/staff/margin/Margin.pdf http://caps.ucdavis.edu/resources/staff/margin/Margin.pdf Half of Us.com – student and celebrity videos on mental health issues. Half of Us.com